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107 Cards in this Set
- Front
- Back
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What is the most often way abdominal trauma is diagnosed?
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Abdominocentesis
-measure PCV/TP, BUN, lactate -cytology -culture and sensitivity |
|
False hernias (traumatic) are more likely to what?
|
form adhesions
cause strangulation |
|
What are the most common locations for traumatic abdominal hernias?
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paralumbar (weakest part of the wall)
caudoventral (prepubic tendon avulsion) |
|
What is the most common concurrent injury with intra-abdominal trauma?
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orthopedic (esp. pelvic)
|
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Normally, abdominal traumatic hernia surgery is scheduled 3-5 days after trauma to allow inflammation to subside and better able to hold suture. When is emergency surgery considered?
|
strangulation of viscera
continued deterioration penetrating wounds |
|
How are the following things repaired?
-prepubic tendon rupture - paracostal hernias |
prepubic tendon rupture - suture to pubis
paracostal hernias - circmcostal sutures |
|
What are the most common injuries that cause hemoabdomen?`1
|
trauma to: spleen, liver, kidney
-UP TO 38% -mortality is 27% |
|
What is seen on US with hemoabdomen?
|
-peritoneal fluid
-organ damage - FAST technique (Focused Abdominal Synography for Trauma) |
|
What is the accuracy of abdominocentesis vs. diagnostic peritoneal lavage when diagnosing hemoabdomen?
What are you looking for with the fluid? |
abdominocentesis - 50-60% (need 6 ml/kg fluid)
DPL - 80-100% (need 1 ml/kg) -doesn't clot, PCV, creatine |
|
When would you go to surgery for hemoabdomen?
|
-increasing volume
-increasing PCV of effusion -unable to stabilize patient |
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What are 2 medical therapies for hemoabdomen?
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abdominal counterpressure wrap (contraindications are: thoracic trauma, resp. compromise, diaphragmatic hernia)
blood transfusion |
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What percent of penetrating abdominal wounds have damage to abdominal viscera?
|
70%
|
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Which abdominal traumatic wounds are surgical emergencies?
|
-penetrating abdominal wound
-evidence of septic peritonitis |
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Which abdominal wounds would you stabilize then go to surgery?
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-uroabdomen
-abdominal wall hernia |
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Which abdominal wounds do you manage conservatively?
|
hemoabdomen
|
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What are 4 effects of peritonitis?
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1 - effusion
2 - inactivated fibrinolytic system 3 - illeus 4 - reflex rigidity |
|
What are the top 4 sources of peritonitis?
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1 - GI
2 - Urogenital 3 - Hepatobiliary System 4 - Penetrating FB *usually polymicrobial infections E. coli and B. fragilis |
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What are virulence enhancing factors for peritonitis?
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bile salts
gastric mucin hemoglobin barium |
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When evaluating an animal for peritonitis, what 2 biochemical tests do you run on the fluid?
|
glucose - 20 mg/dL less than blood glucose
lactate - 2.0 mmol/L greater than blood glucose |
|
What are treatments for peritonitis?
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-fluid resuscitation because lots of fluid and protein loss (similar to burns)
-IV antibiotics (broad spectrum initially) -treat DIC, hypoproteinemia, anemia -GI protectants |
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What types of closure options are there for peritonitis?
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open -loose cranial 2/3 of incision with sterile bandage over top
closed - closed suction drain (Sump-Pump, Jackson Pratt, VAC) |
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What things must be monitored with peritonitis?
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BP
BW Urine output hematology ECG |
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What is the prognosis for peritonitis?
What are negative indicators? |
20-67% mortality depends on ability of surgery to control contamination
-preop hypotension,/hypoalbuminemia, very young or old, |
|
Larygeal paralysis is caused by paralysis of the recurrent larygeal nerves which leads to what?
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neurogenic atrophy of the dorsal cricoarytenoid muscle and paraysis of the arytenoid cartilages
|
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What drugs are good to help diagnose larygeal paralysis under a light plane of anesthesia?
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1 - thiopental alone
2 - doxapram exagerates paralysis if present |
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Other than observation of the larynx, what are other diagnostics that you could perform in an animal you suspect of having larygeal paralysis?
|
1 - neuro exam
2 - esophagram 3 - thoracic rads 4 - thyroid panel 5 - cervical radiographs 6 - electrodiagnostics |
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What is the goal of surgery for larygeal surgery?
|
enlarge the glottis
-arytenoid lateralization is the most common --> tied back to thyroid or cricoid cartilage |
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What is the long term complication of tie back procedure?
|
good for short term - 90%
poor for long term - progressive neuro deficits |
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What are methods for surgically correcting larygeal paralysis?
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1 - tie back
2- partial larygectomy 3- castellated larygofissure 4-reinnervation 5 - permanent tracheostomy |
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What is the complication rate to partial larygectomy?
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50%
-webbing is common -aspiration pneumonia |
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What is a castellated larygofissure?
|
-castellated incision in ventral thyroid that widens the glottis
-vocal folds removed and mucosa closed |
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What are indications for a permanent tracheostomy?
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1 - dogs with higher risk of aspiration pneumonia
2 - severe larygeal collpase 3 - failed larygeal surgery |
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What is the difference between Hansen Type I and Type II IVDD?
|
I - chondroid metaplasia, disc extrusion, more common
II - fibroid metaplasia, disc protrusion, annulus fibrosis hypertrophy |
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What is the most common location for cervical disc herniations?
Most uncommon? |
common - C2-3
uncommon C7-T1 |
|
What percentage of dogs have a unilateral forelimb lameness with cervical IVDD?
Are neuro deficits more common or less common with thoracolumbar deficits? |
50%
more common |
|
What percentage of animals with cervical IVDD are tetraparetic?
|
40%
26% are ambulatory |
|
What are infectious R/O for cervical IVDD?
|
1 -Diskospondylitits
2 - Toxoplasmosis 3 - RMSF 4 - Neosporosis 5 - Cryptosporidiosis |
|
When diagnosing cervical IVDD, what are key features to look for on the radiograph and myelography?
Which test provides better detail of the spinal cord?1 |
rad
1 - narrowed disc space 2 - indistinct iv foramen (horse's head) 3 - calcified disc material in the canal myelography -extradural spinal cord compression -MRI provides better detail of the spinal cord |
|
How many stages are there to cervical IVDD?
Which have good prognosis with cage rest? Which have excellent with surgery? |
7 stages
-I and II, maybe III -2-5 |
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What is the difference between stage 2 and 3 cervical IVDD?
|
2- severe neck pain, one episode
3 - severe neck pain, repeated episodes |
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What is the difference between stage 4 and 5 cervical IVDD?
|
4 - ambulatory tetraparesis
5 - ambulatory tetraparesis (weak)) |
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What is the difference between stage 6 and 7 cervical IVDD?
|
6 - non-ambulatory tetraparesis (55% recovery with complete recovery)
7 - non-ambulatory tetraparesis with sensory deficits (surgery is guarded) |
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What are 3 types of analgesics to use on dogs with cervical IVDD that need 3-4 weeks of crate rest?
|
1 - antiinflammatories
2 - muscle relaxants (methocarbamol, diazepam) 3 - corticosteroids |
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What are 3 options for surgery with cervical IVDD?
|
1 - ventral slot
2 - disc fenestration 3 - dorsal decompression |
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What may a ventral slot result in?
|
vertebral fusion and domino lesions
|
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What are 3 main complications to ventral slot?
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1- hemorrage -> vertebral sinus or artery laceration and compressive hematoma formation
2 - vertebral instability (subluxation) 3 - spinal cord injury (impairment of ventilation) |
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What is accomplished with a disc fenestration?
|
nucleus pulposis is scooped out
|
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What is removed with a dorsal laminectomy?
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dorsal spinous process - window is burred into the lamina
|
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What is included in the immediate post-op care with cervical IVDD surgery?
|
-monitor of respiration and neuro status
-turning and monitor of skin for pressure sores -analgesia |
|
What percentage of congenital AO subluxations occur due to an absent or hypoplastic dens?
malformed dens? |
absent or hypoplastic dens (45%)
malformed dens (30%) |
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What is the typical signalment of animals with an AO subluxation?
|
toy
< 1year (55%) |
|
What are concurrent problems with AO subluxation?
|
-hydrocephalus
-hepatic encephalopathy (PSS) |
|
Why is myelography not a good idea with AO subluxation?
|
post-seizures can be fatal
|
|
What type of treatment is better for dens fractures?
|
neck brace --> head and neck in extension, bandage is cranial to the ears
|
|
What is the treatment for congenital AO subluxation?
What is the prefered approach? |
surgery
-ventral stabilization (preferred approach) -dorsal stabilization |
|
What is the ventral stabilization for AO subluxations?
What is the time for crate rest after this procedure? |
-pins and PMMA
-transarticular fixation -6-12 weeks with external splint |
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What are complications to ventral stabilization with AO subluxation?
|
-death - up to 20% from cardiac or resp. failure
-larygeal paralysis -tracheal necrosis |
|
What about the thoracolumbar area allows for acute, rapid Hansen I disc extrusion?
|
intercapital ligaments T10-T11 caudally
-this is the most common region for IVDD (85%)--> usually UMN signs |
|
What is the order of loss of neuro deficits? (5)
|
1 - spinal hyperpathia
2 - loss of CP 3 - loss of motor function 4 - loss of superficial pain 5 - loss of deep pain |
|
How many stages are there to thoracolumbar IVDD?
Which stages do you consider surgery? |
4
3,4 |
|
Name the stages of throacolumbar IVDD.
|
1 - back pain +/- CP
2 - recurrent back pain, ambulatory paraparesis 3 - non-ambulatory paraparesis - +/- back pain 4 - paraplegia |
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Myelomalacia affects 10% of deep pain negative dogs. What is it?
|
1 - CT moves cranially
2 - UMN --> LMN 3 - loss of abdominal tone 4 - abdominal breathing |
|
What are the 3 techniques for thoracolumbar IVDD?
|
1 - hemilaminectomy (ventral or lateral disc material)
2 - dorsal laminectomy 3 - disc fenestration |
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With a hemilaminectomy, what do you remove with rongours?
|
articular processes and burr window over lamina of adjacent vertebrae, remove disc material an dcover defect with a fat graft
|
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What are complications for a dorsal laminectomy with thoracolumbar IVDD?
|
laminectomy membrane
-greater instability |
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Does disc fenestration treat spinal cord compression?
|
no
|
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What type of nursing care is most important with thoracolumbar IVDD?
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-bladder expression, urinary catheterization
-pharm assistance - alpha agonists --> Phenoxybenzamine, prazosin --> muscle relaxants - diazepam |
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What is the recurrence of CS with TL IDDD?
|
20%
-25% in Dachshunds -15% in other breeds |
|
What is in the inner ear?
|
-semicircular canals
-chochlea |
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What is the blood supply to the pinna?
|
caudal auricular artery and vein
|
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What is a TECA?
|
-removal of horizontal and vertical ear canals combined with a lateral bulla osteotomy
|
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Are drains indicated with a TECA?
|
no
|
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What are keys to post-op care with a TECA?
|
1- bandage
2 - lub eyes 3 - analgesia 4- antibiotics 5 - e-collar |
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What is the most common concern with a TECA?
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facial nerve paralysis - can be entraped on the calcified material - usually resolves in several weeks
|
|
What nerves do you need to watch out for when performing a ventral bulla osteotomy?
|
- lingofacial vein
-hypoglossal nerve |
|
What are CS of feline inflammatory polyps?
|
could be:
1 - upper resp. signs 2 - otitis externa/media/interna |
|
What is the recurrence of inflammatory polyps with:
traction avulsion bulla osteotomy |
-traction avulsion - 30% - post-op corticosteroids will reduce this
bulla osteotomy - < 2% |
|
What are the most common aural neoplasias in dogs and cats?
|
dogs
1 - ceruminous gland adenoma/adenocarcinoma 2 - papilloma 3 - histiocytoma cats 1 - SCC (pinna) 2 - ceruminous gland adenoma/adenocarcinoma |
|
What neoplasias are most common in the pinna - and which are more common in the cat?
|
1 - SCC - white cat
2 - basal cell tumors - cats 3 - melanoma - cats - either beinghn or aggressive 4 - Mast cell - benign in cats, aggressive in dogs 5 - histocytoma - dogs |
|
What type of tumor is the SCC on the pinna of cats?
|
-locally aggressive with a low met rate
|
|
What are the 3 surgeries for SCC of the pinna?
|
1 - pinnectomy
2 - cryosurgery - limited to less than 5 mm superficial lesions 3 - photodynamic therapy |
|
Tumors of the external ear canal in dogs and cats is usually malignant. What percent in dogs and cats?
|
cats - 88% (ceruminous gland adenocarcinoma is most common); also scc and sebacious gland adenocarcinoma, carcinoma of undetermined origin
dogs - 60% |
|
What are congenital causes of diaphragmatic trauma?
|
-peritoneopericardial
-pleuroperitoneal |
|
The 3 muscles of the diaphragm insert on the central tendon and these are innervated by what?
|
phrenic nerves - 5th, 6th, 7th
|
|
Where are the common locations for diaphragm tears?
|
-circumferential tears (40%) along the ribs - more common in cats
-radial tears (40%) along the muscle fibers - less common in cats -20% combo |
|
Respiratory dysfunction (dyspnea and tachypnea are the most common CS of diaphragmatic hernias) what does this result in?
|
-V/Q mismatch
-shunting of blood -hypoventilation -hypoxia |
|
What percent of thoracic rads with diap. hernia have pleural effusion? Gas filled viscer?
|
pleural eff - 25%
gas filled viscera - 60% |
|
What is part of the initial stabilization for diaphragmatic hernias?
|
1 - supp oxygen
2 - min. stress 3 - treat hypovolemia/shock 4 - analgesia 5 - elevate 6 - gastrocentesis 7 - thoracostomy tube |
|
What are indications for emergency surgery with diaphragmatic hernias?
|
1 - gastric herniation with tympany
2 - hemorrhage with hypovolemia 3 - unremitting abdominal pain 4 - sig. resp. compromise |
|
What are the complications after a diapragmatic hernia surgery?
|
1 - re-expansion pulmonary edema - most significant --> must gradually restore negative pressure over 12-24 hours
2 - Loss of Domain - increased intraabdominal pressure which can decrease the blood flow to the viscera --> ileus, dehiscenece, visceral ischemia, pain, hiatal hernia |
|
A pleuroperitoneal hernia is failure of the pleuroperitoneal canal to close. What type of defect is this?
|
Dorsolateral defect +/- central tendon defect
-autosomal recessive inheritance in dogs and rapidly fatal |
|
What is the most common pleuroperitoneal hernia?
|
peritoneopericardial hernia
-failure of the transverse septum development -peritoneal cavity is continuous with pericardial cavity |
|
what signs are more common with peritonealpericardial hernias?
|
GI signs - anorexia, poor growth, ect
Pericardial effusion - cardiac tamponade and RHF |
|
Cervical vertebral fractures are most common where?
|
cranial
50% at C2 - dens |
|
Are cervical or TL fractures more common?
Where are TL fractures most common? |
TL
- 55% between T10-L2 -articular facets change directions from VD to sagittal |
|
What percentage of vert fracures are lumbar?
|
30% with cranioventral displacement of caudal seg due to muscles
|
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What type of injury is common in cats?
|
sacrococygeal - tail pull
|
|
Severity of spinal cord damage with vertebral fracture depends on what?
|
velocity, duration, and degree of compression
|
|
What makes up the dorsal column?
|
-laminae
-spinous processes -articular facets -ass. lig. |
|
What is the Schiff-Sherrington Phenomenon?
|
-severe injury to thoracolumbar or lumbar cord with extensor rigidity of forelimbs but normal reflexes and postural reaction
|
|
What is spinal shock?
|
loss of reflexes caudal to the lesion - mimics LMN lesion
-seen in first 24-48 hours after injury -still have panniculus |
|
What is the most useful for diagnosing spinal cord trauma?
|
rads
-VD or DV only if cross table capability -CT is the modality of choice -myelography is not recommended because requires additional manipulation and adds very little information |
|
What is the clinical presentation of tail pull injuries?
|
-limp tail with no deep pain
-urinary incontinence -soft tissue injury -prog is poor if urinary incontinance after 4 weeks |
|
What is the minimal time for cage rest with vertebral fractures?
|
4-6 weeks
|
|
Is surgery recommended with cervical fractures?
sacral fractures? |
no - high mortality (hemorrhage or further injury)
no - severe only with progressive neurodeficits |
|
What are goals of surgery to fix vertebral fractures?
|
1 - realignment
2 - decompression 3 - stabilization |
|
What types of methods are there for stabilizing verebrae?
|
1 - External Skeletal Fixation
2 - vertebral body plating - not suitable caudal to L4 (sacrifies the nerve root) 3 - pins and PMMA - anywhere and any sized animal 4 - dorsal spinous precess plating - plastic plates on 3 processes cranial and caudal to the fracture 5 - modified segmental fixation - cheep and any part of the spine in any sized dog |
